In what political pundits called a sweeping win by Democrats in Tuesday’s elections, affordability and costs of living emerged as the issues that mattered most to voters. It’s no surprise.
Since 2019 before the pandemic, prices have increased for American businesses and households due to inflation:
Personal Consumption Expenditures (PCE) inflation which measures monthly business spending increased 3.5% annually. The Consumer Price Index (CPI), which measures monthly changes in household spending increased 3.87% annually over the same period (2019-2025).
But in the same period, prices for healthcare services–hospitals, physician services, insurance premiums and long-term care–have taken an odd turn: for businesses, they’ve decreased but for consumers, they increased. It reflects the success whereby businesses have shifted health benefits costs to employees or suspended benefits altogether, and it explains why consumers are bearing more direct responsibility for healthcare costs and are increasingly price sensitive.
A proper interpretation of PCE and CPI data points to a bigger problem: household exposure to increased prices hits younger, middle-income households hardest because their housing costs consume 36-60% of their disposable income. Food costs are an additional 13-20%. That doesn’t leave much room for healthcare when child care, student debt and transportation costs are factored.
| Category |
PCE |
CPI |
CPI Weight |
| 2019-2025 Cumulative
Annual change |
+17.3%
+3.5% |
+26%
+3.87 |
100% |
| 2019-2025 Cumulative Healthcare Services Annual Change | -11.6%
-1.85% |
+16.8%
+2.56% |
6.7% |
| 2019-2025 Cumulative Food Cost
Annual Change |
+24.5%
+3.7% |
+30.98
+4.6% |
14.5% |
| 2019-2025 Cumulative Housing Cost
Annual Change |
+18-22%
+3.2% |
+25-28%
+4.2% |
44.2% |
| 2019-2025 Cumulative Transportation Cost
Annual Change |
+28-32%
+4.8% |
+35-40%
+5.5-6.0% |
15.1% |
Sources: Personal Consumption Expenditures Price Index | U.S. Bureau of Economic Analysis (BEA), CPI Home : U.S. Bureau of Labor Statistics
Increased attention to household affordability and costs of living is uncomfortable in the healthcare industry. The good news is that expenses for health services represents a small fraction of spending; the bad news is those expenses are increasing along with competing categories and they’re sometimes unpredictable.
The fundamental operating model in healthcare is ‘Business to Business/B2B’ transactions between producers (physicians, hospitals, drug and device makers), middlemen (insurers, PBMs, employers) and users (consumers) reinforced by state and federal regulation that protect the status quo. And ‘users’ are treated as patients or enrollees, not a market that makes buying decisions based on value and costs. Thus, lack of price transparency in healthcare coupled with lack of predictability when services are used lends to public confusion or, in extreme cases, contempt. The public reaction to the murder of UnitedHealth Executive Brian Thompson last year surfaced the public’s latent animosity toward healthcare’s business practices that treat consumers as pawns on a complicated chessboard.
Shifting direct financial responsibility to consumers is the blunt instrument touted by economists who rightly argue informed decision-making by consumers is necessary to lower costs and improved value from the system. It won’t happen overnight if at all, and the system’s affordability in working age households will be the impetus.
The near-term implications are clear:
Increased household discretionary spending for necessities (food, transportation, and housing) will shrink discretionary spending for healthcare products and services:
- Consumers believe their basic needs—food, shelter, transportation–are easier to predict and manage than their out-of-pocket bills for insurance premiums, co-pays, deductibles, over-the-counter products and more. 60% are financially insecure, and unanticipated medical costs is their biggest concern.
- Consumers think the healthcare system is ‘dominated by ‘Big Business’ that prioritizes profit before everything else. The majority of consumers in every age, income, education, ethnic and partisan affiliated cohort share this view and are dissatisfied. Elected officials in both parties believe consolidation in health services has increased prices and reduced competition for consumers. The frontline healthcare workforce is demoralized by its corporatization and resentful of leaders they consider overpaid and accountable for financial results only.
Consumers (voters) will support policy changes to the health system that increase its accountability for affordability.
- Among providers, momentum for price controls, price transparency, executive compensation limits, justification for tax exemptions, revenue cycle management practices, will be strong especially in state legislatures.
- Among insurers, claims data accessibility, standardization & justification of coverage, denials, prior auth and network adequacy, premium pricing, administrative cost accountability, executive compensation, will be foci of regulation.
- Among suppliers to the health services industry—drug companies, device makers, information technology solution providers, consultants and professional services advisors, supply chain middlemen et al—disclosure of business relationships and transparency re: direct and indirect costs will be mandated.
Final thought:
Throughout my career, ‘patient centeredness” has been the fundamental presumption on which service delivery by providers has been justified. Affordability has been neglected though increasingly acknowledged in rhetoric. Executives in healthcare services are not compensated for setting household affordability targets and publicly reporting results. Most compensation committees and Boards have marginal understanding of household economics in their communities and depend on “revenue cycle management” to address consumer payment obligations at arms-length. Even the medical community is not immune: one in 5 medical students is food insecure, 4 of 5 medical residents is financially insecure, and their career choices are increasingly dependent on their earning potential. So, calls for greater attention to affordability in healthcare will originate from insiders and outsiders tired of excuses and lip service.
Insecurity about household finances is significant and growing. Per the University of Michigan Index of Consumer Sentiment (50.3 in November 2025) is near an all-time low. It’s reality in the majority of U.S. households. The federal shutdown, discontinuance of SNAP benefits, cuts to ACA subsidies for insurance, corporate layoffs and higher costs for child care, groceries, gas and housing are a tsunami to American households.
Last week, voters elected: Zohran Mamdani, 34 (NYC); Abigail Spanberger, 46 (VA); and Mikie Sherrill, 53 (NJ) in races touted as a weather-vane for elections in 2026 and beyond. It is bigger than partisan elections. Voters in both parties and across the country are worried about affordability. It’s especially true among younger generations who worry about making ends meet and think institutions like the political system, higher education, organized religion and healthcare are outdated.
Healthcare service providers can ill afford to neglect affordability. It more than measuring medical debt, posting prices and referencing concern on websites. It’s about earning the trust and confidence of future generations through concrete actions that increase household financial security beginning with healthcare spending.
Paul
PS As never before, the voices of younger generations are being heard across the country though social media and demonstrations. The health system is among their major concerns as they ponder how they’ll be able to pay for their bills While Medicare seems the focus to policymakers and beltway pundits who rightly recognize seniors as its most costly population, the working age population has been taken for granted. Here’s a voice I follow closely. Fresh Perspective Is Sometimes Needed – by K. Pow
Sections in this report:
- Corporate Announcements week of November 3
- Economy
- Hospitals
- Insurers
- Physicians
- Polling
- Prescription Drugs
- Public Health
Quotables
K Pow on Premium tax credits: , “I think it’s laughable people actually believed we could make health insurance affordable by creating a marketplace of “qualified” plans- which now only captures ~25M Americans- by subsidizing payors through a premium tax credit that’s virtually useless to what’s left of the middle class based on the way it’s calculated. Of course, proponents would argue the ACA wasn’t designed for that cohort, but I don’t think people truly understand just how hollowed out the middle class has become…
And it only makes sense PTCs scale based on earnings (FPLs 100%, 150%, 250% etc), meaning you’re less likely to qualify the more you make. But as you can see below, you basically have to be destitute to scrounge the smallest morsel EVEN under the enhanced version of the PTC- which was rolled out in 2021 and suspended the 400% FPL threshold, allowing folks on the higher end of being broke to qualify for crumbs. Sounds equitable in passing- which is all it is- until you run the numbers yourself.
So, the reason I talk about housing so much is because the healthcare industry doesn’t really understand or appreciate how it could impact their business- many suffer from siloed thinking…”.
Fresh Perspective Is Sometimes Needed – by K. Pow
President Trump on ACA: “I am recommending to Senate Republicans that the Hundreds of Billions of Dollars currently being sent to money sucking Insurance Companies in order to save the bad Healthcare provided by ObamaCare, BE SENT DIRECTLY TO THE PEOPLE SO THAT THEY CAN PURCHASE THEIR OWN, MUCH BETTER, HEALTHCARE, and have money left over. In other words, take from the BIG, BAD Insurance Companies, give it to the people, and terminate, per Dollar spent, the worst Healthcare anywhere in the World, ObamaCare. Unrelated, we must still terminate the Filibuster!”
Trump Drops New Plan To ‘Terminate’ Obamacare In Saturday Morning Rant
Trump on prices, affordability: “Our energy costs are way down. Our groceries are way down. Everything is way down. And the press doesn’t report it. So, I don’t want to hear about the affordability. Because right now, we’re much less.”
Trump’s optimistic perspective on the economy is at odds with government statistics and the views of many voters, according to pollsters and analysts. The Labor Department reported last month that consumer prices rose 3% in September from a year earlier, marking the fastest pace since January. In recent surveys, voters said the cost of housing, groceries and utility bills is unmanageable. Democratic candidates who focused their messages on affordability came out on top in Tuesday’s elections, handily beating their Republican challengers.
In the Oval Office on Friday, Trump lashed out at reporters who pressed him on the cost of living. “We are much better than Biden,” he said. “We are the victors on affordability.”
Trump Dismisses Affordability Concerns; Insists Prices Are Coming Down – WSJ
Washington Post on fraudulent disability claims by Veterans Health organizations: “Disability ratings of 100% once were granted to only the most incapacitated veterans, typically those whose war wounds precluded them from taking civilian jobs. But today the maximum rating is the most commonly held one by far. Of the roughly 6 million veterans receiving disability payments last year, about 1.5 million were designated 100% disabled — a nearly ninefold increase since 2021 — the most recently available VA figures show…
But a Washington Post investigation found that for-profit consultants like Combat Craig are compounding the spike in ratings with manipulative tactics. Many urge veterans to stretch the truth about their ailments and claim hard-to-disprove conditions that VA is unlikely to challenge, such as migraines, erectile dysfunction and post-traumatic stress disorder, or PTSD. By promising higher ratings and bigger disability checks, they have persuaded millions of veterans to pay as much as $20,000 for their services.
The surge in 100% ratings is primarily driven by a younger generation of veterans who served in the aftermath of the 9/11 attacks. A Post analysis of U.S. Census Bureau data found that employed veterans between the ages of 26 and 35 account for the biggest increase in ratings between 70 and 100%.”
The unregulated industry that coaches veterans to pile on benefits – Washington Post November 5, 2025
Theil on generational discontent: “If you graduated in 1970 with no student debt, compare that to the millennial experience: too many people go to college, they don’t learn anything, and they end up with incredibly burdensome debt. Student debt is a version of this generational conflict that I’ve talked about for a long time.
The rupture of the generational compact isn’t limited to student debt, either. I think you can reduce 80% of culture wars to questions of economics—like a libertarian or a Marxist would—and then you can reduce maybe 80% of economic questions to questions of real estate.
This is an obnoxious answer of sorts, but it’d be like: The political establishment, the leaders we have, will actually solve some of these problems, and this is the last time we’re going to have this conversation. And if you ask to talk to me a bunch of times over the next 10 years, that won’t be healthy, because it will be because these problems haven’t been tackled or solved. The reason I’m talking to you, and the reason we’re having this conversation, is that we both suspect that this is going to be the first of many.”
Peter Thiel: Capitalism Isn’t Working for Young People
MedPage on Hospital CEO compensation: “In this uncertain environment, wage equality within hospitals — measured by the ratio between what employees and executives are paid — matters more than ever.
The Big Beautiful Bill arrives at a time when wages are already increasingly unequal across industries. Amongst top publicly traded corporations, CEO compensation grew 1,209% from 1978 to 2022, while the typical worker’s compensation grew only 15.3%. As of 2022, CEOs were paid 344 times as much as a typical worker.
My co-authors and I recently demonstrated that this trend persists in nonprofit hospitals. Our study, published in Health Affairs, found that wages for nonprofit hospital CEOs grew by 27.5% from 2009 to 2023, while the average wage for all employees (inclusive of executives) increased by only 9.8%. In 2023, nonprofit hospital CEOs were paid 12 times the average wage of all hospital workers, with the average CEO salary exceeding $1 million annually. The COVID-19 pandemic put only a small dent in this trend, with the CEO-employee wage gap continuing to grow post-2020…
we should take a long and hard look at how much our nonprofit healthcare executives are compensated…
In recent years, critics have questioned whether nonprofit hospitals are doing enough to deserve these exemptions: studies have shown that non- and for-profit hospitals provide comparable levels of charity care in terms of percentage of total expenses and that the amount of charity care provided does not increase as hospital profits grow…
In a country that prides itself on its democratic principles, wage equality matters — it allows us to better sustain economic opportunity. The U.S. healthcare system employs around 11% of our nation’s workforce, and these “essential workers” should be compensated commensurate with their contributions to keeping our hospitals running. Wages within healthcare are deeply and increasingly unequal, and the financial burdens of the Big Beautiful Bill can either exacerbate or help alleviate this trend. We must ensure that patients and workers remain in focus as health systems adapt and restructure.”
Hospital CEO Pay Is Too Damn High | MedPage Today
Modern Healthcare on CMS Physician Compensation Efficiency Adjustment: “Medicare on Friday followed through with its earlier proposal to reduce payment for surgeries, outpatient procedures, and other services it believes can be done more efficiently starting in 2026.
The controversial move represents a significant change to how thousands of physician services are priced under Medicare. It’s a blow to the powerful physician lobby that has long controlled how procedures are priced, and could help ensure more equitable pay between specialists and primary care doctors.
The so-called efficiency adjustment assumes that advances in technology and standardized workflows have cut down the time and expense necessary to perform certain procedures — changes that reimbursement hadn’t accounted for. Those services will see a 2.5% cut to reimbursement beginning Jan. 1, 2026, while time-based services like office visits or behavioral health therapy will not. Telehealth and certain maternity services will also be unaffected.
“CMS is reinforcing primary care as the foundation of a better health care system while ensuring Medicare dollars support real value for patients, and not the kind of waste or abuse that erodes trust in the system,” Medicare Director Chris Klomp said in a statement. “Our goal is simple: deliver better outcomes for patients and be wise stewards of the taxpayer resources that make Medicare possible.”
CMS finalizes Medicare pay hike for doctors https://www.modernhealthcare.com/politics-regulation/mh-medicare-physician-pay-2026-final-rule/
Corporate Healthcare News week of November 3, 2025
OpenAI has agreed to pay Amazon $38 billion for computing power in a 7-year deal that marks the first partnership between the startup and the cloud company. Amazon expects that all of the computing capacity negotiated as part of the agreement will be available to OpenAI by the end of next year, giving the ChatGPT maker quick access to powerful Nvidia chips housed inside its data centers.
OpenAI, Amazon Sign $38 Billion Cloud Deal – WSJ November 3, 2025
Hinge Health which contracts with employers, pharmacy benefit managers and large insurers to provide physical therapy and pain relief reported revenue of $154.2 million, a 53% increase from $100.6 million in the third quarter of 2024. Its free cash flow, the amount by which a business’s operating cash flow exceeds its working capital, was $81.3 million, compared with $27.5 million last year.
Hinge Health’s AI investment boosts Q3 revenue following IPO – Modern Healthcare
Economy
Federal Reserve Household Debt Report: Household debt increased to $18.6 trillion, up nearly $200 billion in the third quarter. Credit-card debt hit another record at $1.23 trillion. Delinquencies remain “stable,” but that stability is deceptive: serious delinquencies are up 80% from this time last year, student-loan defaults are near 10%, and the share of borrowers rolling over balances every month is rising. Americans are borrowing just to stand still.
The pattern runs through affordability metrics, too. Auto-loan delinquencies are now higher than both credit-card and mortgage delinquencies, with one in five borrowers paying more than $1,000 a month for a car. The median age of a first-time homebuyer has surged to 40, the highest on record, as prices and rates lock younger Americans out of ownership entirely. Even travel has lost altitude — Las Vegas visitor traffic is down 9% this year, the steepest drop since 2008.
ADP Jobs Report for October: U.S employers added 42,000 jobs in October. Annual pay was up 4.5%, unchanged from September.
Hiring was concentrated in education and health care (+26,000) and trade, transportation, and utilities (+47,000). Meanwhile, white-collar and consumer-facing industries continued to shrink, and shrink fast. Professional and business services (–15,000), information (–17,000), and leisure and hospitality (–6,000) all shed jobs for a third straight month.
ADP report shows jobs growth as white-collar layoffs accelerate
CBO: Cost of subsidy extension: Extending the subsidies would cost the federal government around $23 billion next year and about $350 billion over the next decade, according to estimates from the Congressional Budget Office.
“CBO and JCT estimate that permanently enacting the expanded premium tax credit structure would increase deficits by $349.8 billion over the 2026–2035 period. Using HISIM2, CBO’s health insurance simulation model, the agency estimates that the number of people with health insurance would increase by 3.6 million in 2030 and by 3.8 million in 2035. CBO also estimates that gross premiums for benchmark plans in the marketplaces would be 7.6% lower, on average, in each year from 2026 to 2035, relative to baseline projections.”
Bloomberg on market correction: ”…the last time the S&P 500 had a 24-month period with no 10% drawdown was roughly between February 2016 and February 2018. So, the market is due. And there are plenty of reasons to think stocks are overheating. Looking just at US stocks, the Bloomberg on stock market: S&P 500 is up 38% from the April low, adding almost $17 trillion in market value. The gains have been driven by an increasingly narrow slice of the market — the AI plays — and the rally has pushed valuations toward the high end of their historic ranges even as the economy has slowed.
Markets are most irrational at the heights of a bull market and the depths of a bear market, said Citadel CEO Ken Griffin, who added that now “we are very deep into a bull market.”
Investors Take Fright at the Idea That Stocks Can Go Down – Bloomberg November 4, 2025
Restaurant market responding to consumer pressure: “Amid a busy few weeks for restaurant earnings, new data is emerging that suggests a restaurant recession could be underway. The pullback is most marked among the young customers who have long propped up the boom in “fast-casual” restaurants — chains built on recognizable ingredients, counter service, and prices roughly 50% higher than fast food.
Shares of Chipotle fell some 5% last week after the chain’s earnings report showed that margins fell and comparable-store sales growth appeared barely positive. Sweetgreen and Cava, both of which report earnings this week, are similarly plunging as investors anticipate hard-hit margins, weaker traffic, and challenging same-store sales.
Behind it all is a weakening job market and a tidal wave of loan delinquencies that experts warn could prove far larger than past default crises. When younger customers’ budgets tighten, “fast-casual” becomes neither fast nor cheap enough. And that leaves chains built on millennial and Gen Z loyalty facing a sobering reality: Even beloved brands can’t escape the pullback.”
Restaurant recession rears its head as Chipotle, Sweetgreen hit hard
Home equity decline: “Home equity has been booming as prices soared, but that era is ending and a troubling new trend is inching up.”
Equity-rich homes decline as underwater mortgages rise – Nashville Business Journal November 3, 2025
Hospitals
AEH Report: Safety-net hospitals: SNHs provided $11 billion in uncompensated care and another $11.4 billion in under-reimbursed care in 2023.
- Of the $11 billion in uncompensated care performed at AEH’s 383 member hospitals in 2023, 70% was charity care for uninsured patients. 22% was non-Medicare bad debt expenses and 8% was charity care for patients with insurance who could not afford their medical bills.
- AEH said Medicaid and Medicare often undervalue the care provided at safety-net hospitals, resulting in shortfalls between what the programs pay and a hospital’s cost of care. Of the $11.4 billion in under-reimbursed care, 86% resulted from Medicaid shortfalls (after disproportionate share hospital payments), 10% from Medicare shortfalls (after DSH payments), 3% from Medicare bad debt, and 1% from state or local indigent care programs.
- Without Medicaid DSH and other Medicaid supplemental payments, essential hospital operating margins would have been -12.4% in 2023. After DSH and other government appropriations, essential hospitals had aggregate margins of -1.6%.
Essential Data 2025: Our Hospitals, Our Patients – America’s Essential Hospitals
Study: Outpatient follow-up activity: Based on a systematic review and meta-analysis of 83 studies:
“Outpatient follow-up within 30 days of discharge was associated with reduced risk of 30-day readmission for patients aged 65 years or older, while early follow-up within 7 and 14 days was associated with reduced risk only among patients aged 65 years or older with heart failure or acute myocardial infarction. The findings suggest outpatient follow-up within 30 days of discharge is associated with reduced risk of readmission but follow-up within 7 or 14 days may not be necessary for low-risk patients.”
Study: Use of remote monitoring devices: This analysis examines patterns in outpatient RPM and RTM use among adults under 65 with employer coverage.
“In 2023, an estimated 300,000 adult enrollees with employer-sponsored health insurance received at least one remote monitoring claim, representing 0.3% of all adult enrollees with six or more months of coverage. Of the enrollees with any remote monitoring, 93% had any RPM claims and 19% had any RTM claims. Some enrollees used both RTM and RPM. Enrollees with RPM claims were most likely to have diagnoses monitoring for circulatory conditions (47% of all enrollees with any RPM claims) or treating hypertension and circulatory diseases (31%). Most enrollees with RTM claims had diagnoses for the management of musculoskeletal disorders (73%). Payments for these services vary, with an average monthly cost per patient of $55 for RPM and $78 for RTM.”
Insurers
Study: Access to health benefits among hourly services sector companies: Of pooled data from 19 885 hourly workers (weighted 52.4% female; weighted 46.2% aged 18-29 years), large shares of workers in the hourly service sector occupy the employer provision exemption categories. Nearly 30% were part-time, 26% worked at a franchised firm, and 17% had short tenure. More than one-half (54%) were excluded as members of at least one category
Physicians
Study: Primary care workload: Researchers reviewed primary care physicians’ activity logs from 33 clinics (406 physicians) in 2021. Results:
- Physicians spent a median of 61.8 hours per week caring for patients, with part-time PCPs investing more time per patient than their full-time colleagues. Panels with older patients, those with greater medical complexity, or more Medicaid enrollees required more time from PCPs.
- Median yearly work effort per 1.0 cFTE ranged from 3480.8 hours for PCPs with a cFTE less than 0.5 to 2401.5 hours for PCPs with a cFTE of 0.75-1.25. The median yearly work effort for full-time PCPs was 2844.3 hours, equivalent to 61.8 hours per week. The median time per patient was 1.7 hours per year.
Study: Government-sponsored primary care enhancement programs: This systematic review of 142 programs found that investing in primary care was associated with improvements in practice experience and population health, while outcomes regarding patient experience, costs, and utilization were mixed. Access to practice-level data and payment system challenges limited these impacts, and most outcomes were not seen until after at least 2 years. Countervailing payment incentives may have affected outcomes. Future primary care transformation efforts should focus on addressing practice-level barriers, aligning payment, and targeting support for practice-level organizational improvement based on local needs.
CMS Final Physician Comp for 2026: “The conversion factor for practitioners participating in a qualified alternative payment model (APM) is $33.5675, a 3.77% increase from 2025. For practitioners not participating in an APM, the conversion factor is $33.4009, a 3.26% increase from 2025.
“CMS is reinforcing primary care as the foundation of a better health care system while ensuring Medicare dollars support real value for patients, and not the kind of waste or abuse that erodes trust in the system,” CMS Deputy Administrator and Medicare Center Director Chris Klomp said in a news release. “Our goal is simple: deliver better outcomes for patients and be wise stewards of the taxpayer resources that make Medicare possible.”
Note: For 50 of those specialties, the services provided within the facility would be paid less in 2026, whereas services provided in a non-facility practice would get a pay increase. Some examples of facility versus non-facility rate changes, respectively, include:
- Allergy and immunology: -11% vs +8%
- Endocrinology and gastroenterology: -10% vs +6%
- Hematology and oncology: -11% vs +6%
- Neurology: -9% vs +6%
- Ophthalmology: -13% vs +3%
- Otolaryngology: -12% vs +3%
- Podiatry: -9% vs +3%
CMS Releases 2026 Physician Fee Schedule Final Rule – American College of Cardiology
Study: Medical student demographics: There’s a persistent stereotype that medical students come from wealth. And it’s not entirely unfounded. Statistics show that among students entering medical school for the last 30 years, the top two household income quintiles contributed between 73% and 79% of all matriculants each year. But what about the remaining quarter of students?
“A significant proportion of students attending medical school do not come from these high-income brackets….Meanwhile, a 2025 JAMA Network Open study found that more than a fifth (21%) of medical students were food insecure. Food insecurity was significantly higher among ethnic and racial minority students, students with dependents, and students with financial need.”
Medical Students Need to Eat Too | MedPage Today
STAT analysis: Physician comp in Optum groups: “This descriptive study used Centers for Medicare and Medicaid Services payer transparency data for the employer-sponsored and individual markets to show that when the relative price paid to Optum versus non-Optum providers is analyzed, UnitedHealthcare’s payments are 17% higher than the relative price of its competitors. In markets where UnitedHealthcare has 25% or more market share, this percentage increases to 61%. The results suggest that intercompany transactions within health care conglomerates may warrant scrutiny, as they may be signals of regulatory gaming or attempted foreclosure.”
UnitedHealthcare Pays Optum Providers More Than Non-Optum Providers | Health Affairs November 3, 2025
Polling
KFF Tracking poll: Highlights of KFF Health Tracking Poll of 1350 U.S. adults conducted October 27-November 2, 2025:
- About three quarters of the public continue to say Congress should extend the expiring tax credits, including more than nine in ten (94%) Democrats, three in four (76%) independents, and half of Republicans. As the debate continues, this poll shows that partisan loyalties among the public are deepening, with Republicans split over whether they want Congress to extend the tax credits for people who purchase their own coverage on the ACA marketplaces or allow them to expire.
- Democrats largely support what congressional Democrats have been doing throughout this debate, while independents are split. A large majority of Democrats (81%) say Democrats in Congress should “refuse to approve a budget unless it includes extending these tax credits, even if it means the government remains shut down.” Independents are divided, while about eight in ten (84%) Republicans say Congressional Democrats should approve a budget to quickly end the shutdown.
- The Democratic Party maintains an edge over the Republican Party when it comes to voter trust of handling the future of the ACA, and a narrower edge when it comes to high cost of health insurance. expire – would have a “major impact” on both their decision to turnout to vote and which candidate they would support, compared to about three in ten Republican voters.
KFF Health Tracking Poll: Public Weighs in on Health Care Debate and Government Shutdown | KFF
CNN on public mood: “Americans are broadly dissatisfied with the state of the country (68% say things are going badly) and the economy (72% say it’s in poor shape, and 47% call the economy and cost of living the top issue facing the US). About 6 in 10 (61%) say Trump’s policies have worsened economic conditions in the US.
Roughly 8 in 10 consider the federal government shutdown a crisis (31%) or a major problem (50%), and 61% disapprove of Trump’s handling of it. Nearly as many disapprove of the way each party’s congressional leadership is handling it (58% disapprove of each). Taken all together, about 9 in 10 American disapprove of at least one of those three players on the shutdown
The CNN poll was conducted October 27 to 30 among a random national sample of 1,245 adults.
Harris Poll: opinions from middle class adults: The poll was conducted September 11- October 17, 2024 among a nationally representative sample of 10,009 adults. The data in this report is shown for a subsample of 5,639 people with an annual household income between $50,000 and $199,999.
- 65% of middle-income adults say they are behind on retirement savings
- 47% have dipped into savings to cover unexpected expenses
- 61% worry they will never be able to retire fully
- 39% say they lack access to employer-sponsored savings plans
Retirement in Balance: The Financial Future of America’s Middle Class – Harris Poll
U of Michigan Consumer Confidence Index November 2025: “Consumers’ moods dropped further in November, according to a monthly survey from the University of Michigan, continuing a slide that has worsened amid persistent price increases and an extended government shutdown.
Americans are facing down an economy with multiple pressure points. Inflation has dropped from the highs that it reached three years ago, but at 3% in September, it has now remained elevated for almost half a decade.
Meanwhile, the labor market has cooled, frustrating job seekers. Amazon.com and United Parcel Service were among the companies announcing high-profile layoffs last month, contributing to a total of more than a million job cuts reported so far this year across the economy. Those job losses are overshadowing a labor market that, by other measures, remains fundamentally solid, with modest net job creation in recent months and a relatively low unemployment rate.”
U.S. Consumer Sentiment Nears Record-Low Levels in University of Michigan Survey – WSJ
Prescription Drugs
Report: Pharmacist Shortage: In 2025, the United States is experiencing its worst pharmacy staffing shortage in two decades.
- The American Association of Colleges of Pharmacy reports 20,053 pharmacist job postings and 39,111 technician postings in Q1 2025 — a 6% year-over-year rise.
- Since 2022, retail pharmacist employment has fallen 9.5%, equal to about 13,000 fewer pharmacists nationally.
- Across hospitals, 80% of pharmacy directors say they can’t fill technician positions, and 60% report clinical pharmacist shortages.
- Vacancy rates are averaging 20% for technicians and 18% for pharmacists, creating systemic gaps in medication verification.
https://www.pharmacytimes.com/view/ncpa-and-usc-launch-first-publicly-available-tool-to-identify-pharmacy-shortage-areas-across-america
Study: Use of pay per click (PPC) in prescription drug marketing: Researchers analyzed use of pay-per-click (PPC) advertising by prescription drug company promotion of semaglutide (Ozempic), a GLP-1RA FDA approved for diabetes, from April 2022 to March, 2024. With PPC, companies bid on keywords related to their products and pay when someone clicks their advertisements. Results:
“PPC advertising prioritizes company websites over other sources, an outcome that may not be apparent to users expecting search results to reflect informational relevance or objectivity. Manufacturers’ websites inevitably emphasize medications’ benefits, risks, and alternatives in ways designed to drive prescriptions…
This approach may influence consumer behavior by increasing the likelihood that individuals, including those for whom the drug may not be FDA approved or clinically indicated, initiate conversations with their clinicians that lead to a prescription. This single-case analysis limits generalizability, and the relatively modest spending observed may reflect regulatory caution, strategic targeting, or reliance on other digital channels.”
Study: Glucagon-Like Peptide-1 Receptor Agonists and Pay-Per-Click Direct-to-Consumer Advertising | Health Policy | JAMA Network Open | JAMA Network October 31, 2025
Public Health
Study: teen vaping habits: Researchers analyzed nationally representative survey data from middle and high schoolers collected annually between 2020 and 2024. In that time, the number of young people who had vaped at least once in the past 30 days declined sharply — except for girls and young Black people, who saw stable rates or slower declines. Among all users, the proportion who vaped nicotine daily almost doubled from 15% in 2020 to 29% in 2024. At the same time, the number of folks who had unsuccessfully tried to quit rose from 28% of daily vapers to 53%.
Trends in Daily Nicotine Vaping and Unsuccessful Quit Attempts in Youths | Pediatrics | JAMA Network Open | JAMA Network November 3, 2025
